Surgical

Surgery is rarely employed in PMS and should be considered only as a last resort (1).

When treating women with severe PMS, hysterectomy and bilateral oophorectomy has been shown to be of benefit

• hysterectomy and bilateral oophorectomy can be considered when medical management has failed, long-term GnRH analogue treatment is required or other gynaecological conditions indicate surgery
• surgery should not be contemplated without preoperative use of GnRH analogues as a test of cure and to ensure that HRT is tolerated

Women being surgically treated for PMS should be advised to use HRT, particularly if they are younger than 45 years of age

When treating women with severe PMS, endometrial ablation and hysterectomy with conservation of the ovaries are not recommended

• bilateral oophorectomy alone (without removal of the uterus) will necessitate the use of a progestogen as part of any subsequent HRT regimen and this carries a risk of reintroduction of PMS-like symptoms (progestogen-induced PMD).

Reference:

• (1) Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician &Gynaecologist 2015;17:99–104